AB0336 MANAGEMENT OF INFLAMMATORY ARTHROPATHIES IN SUSTAINED REMISSION: UNIFICATION OF TAPERING CONCEPT IS ON TIME (THE RESULTS OF E-SURVEY OF UKRAINIAN RHEUMATOLOGISTS)
Authors: I. Biliavska, V. Kovalenko
Journal: Annals of the Rheumatic Diseases (2022)

Background Changes in the management paradigm (early diagnosis, new therapeutic options, implementation treat-to-target (T2T) concept) in patients with inflammatory arthropathies (IA) have led to the fact that disease activity in most cases is suppressing effectively. On the one hand, this improves of long-term outcomes of IA; on the other - it increases risks of overtreatment, adverse events, and financial costs. Objectives The study aimed to estimate trends and approaches among Ukrainian rheumatologists to the tapering disease-modifying antirheumatic drugs (DMARDs) in patients with IA in sustained T2T remission. Methods The anonymous and validated e-survey, based on the initial research hypothesis, was conducted by the Ukrainian Association of Rheumatologists. Its structure consists of 10 questions agreed by the members of the Task Force and approved by the ethics committee. E-survey was designed with digital toll SurveyMonkey and disseminated via email among rheumatologists of Ukraine from the national database. All data received is stored and processed per privacy protection laws. Descriptive statistics were used for the analysis. Results During one month period, 107 responses had received. 82.2% of Ukrainian rheumatologists used validated diseases activity measures in their daily clinical practice regularly. To assess the trends for DMARDs tapering for further analysis, 71 (66.4%) responses are taken from specialists who often/very often prescribe bDMARDs to patients with IA. Only 12 (17.1%) rheumatologists rarely taper DMARDs; 39 (55.7%) - periodically and 20 (28.2%) - very often deescalate DMARDs therapy in their practice. For 35 (49.3%) of responders, the decision doesn’t depend on the type of IA. In the case of combined therapy, 43 (60.6%) start tapering of synthetic DMARD, 19 (26.8%) – of bDMARDs, and 9 (12.7%) with simultaneously tapering of bDMARDs and cDMARDS, respectively. The main criteria for Ukrainian rheumatologists to start dose reduction of DMARDs were state of sustained remission - 30 (42.3%), significant disease activity suppression - 17 (23.9%), financial inability to purchase the drug - 17 (23.9%), adverse events development - 7 (9.9%). The optimal remission duration before tapering for 23 (32.4%) responders was 6-12 months, for 17 (23.9%) – up to 6 months, and for 12 (16.9%) more than 12 months, respectively. Only 19 (26.8%) believe that disease activity suppression and improvement of patient status are enough to start tapering DMARDs. During tapering DMARDs, it was found that for clinical status monitoring, 30 (42.3%) of rheumatologists examine patients monthly, 31 (43.7%) – every 3-months, 7 (9.9%) - on-demand, and only 3 (4.2%) – every 6-months. 43 (60.6%) of specialists had noted that due to the loss of T2T response - full-dosing regimens have to be restored. Financial inability to purchase the drug for 49 (69%) responders is the strong argument to start a dose reduction due to the lack of bDMARDs reimbursement in Ukraine. Conclusion DMARDs dose reduction has become a part of clinical rheumatology practice. The lack of unified recommendations leads to decisions tapering DMARD based mainly on rheumatologists’ knowledge and experience. The standardized approach introduction to DMARD de-escalation would help clinicians support treatment decisions. References [1]Maassen J.M., van Ouwerkerk L., Allaart C.F. (2021) Tapering of disease-modifying antirheumatic drugs: an overview for daily practice. The Lancet Rheumatology; https://doi.org/10.1016/S2665-9913 (21)00224-1 Acknowledgements To all respondents of the survey Disclosure of Interests None declared